The lower extremity is vital for good running form and performance. We all know that strength and endurance are needed to create movement, especially over long distances. But, they are also essential to withstand the stresses of high mileage. A muscle that is stronger will undoubtedly be more resistant to fatigue.
Within all of that, where does stability fit in? I bring this up because too often people are throwing strengthening interventions at a stability problem. If you have an issue maintaining lower limb alignment and control in the sagittal plane, strengthening the hip abductors won’t cause them to stabilize better.
I’ll be the first to say that strengthening those muscles is not a bad thing and most runners can benefit from this. But, we must put the body in a position to develop a rich neuromuscular connection which relies on constant feedback and response from the nervous system. Not to mention, looking at other areas throughout the kinetic chain for weak links and alignment issues.
Here are some random thoughts on creating optimal lower extremity alignment for runners:
1. Neuromuscular Control and It’s Impact on Stability
Neuromuscular control is a term that signifies the body’s connection between the nervous system and muscles. This system is a two way street which relies on sensory input and motor output. Therefore, muscles, joints, skin, and our own awareness send signals to the nervous system, which then respond with a stimulus to maintain or adjust our position.
When we think about stability, this reflexive scenario is essential. During each contact in the gait and running cycle, our nervous system is flooded with sensory information that it needs to assess and quickly respond to. The question is, does your body have the neuromuscular capacity to respond appropriately?
Despite being strong, we must first possess the ability to connect with specific muscles. Ultimately, this connection needs to happen without us consciously thinking about it. But, creating the framework for unconscious control starts with isolation.
Two of my favorite neuromuscular activation exercises for the hip are:
As you complete these movements, focus on connecting with the body and not about sets and repetitions. Performing isometric holds can be valuable which includes lifting to the end-range and holding the movement for 30-60 seconds. This provides more time to assess and adjust each movement to fire the intended muscles.
2. Using Isometric Holds for Better Neuromuscular Activation
When it comes to running, the hip (and foot) is responsible for alignment of the leg. When the hip lacks stability and control, you’ll often notice that the femur moves into internal rotation. This can be seen with someone who falls into a “knock knee” position during gait and running.
Isometric holds can provide a situation where the body has time to appreciate it’s position and adjust to create optimal stability. Oftentimes, runners complete functional movements that are throughout the full range of motion. This is important and necessary, but needs to come once a joint can function in static positions.
Recently, I have implemented the loaded single leg stance, split squat isometric hold, and single leg balance with reach drills to provide more time under tension. These drills allow runners to connect with joint stabilizers so they can fire while maintaining a static position. The increased time of holding these positions often makes deficits in stability become more apparent.
I highly recommend you try these movements as an assessment to determine your level of neuromuscular function. See what you feel and if it is truly the area that needs to be firing. Is one side different than the other?
When the stabilizers aren’t functioning properly, we often find that other areas will compensate. The intended movement can actually look identical, but compensation may cause issues down the road.
3. Train Stability to be Reflexive
Creating “stability” with conscious thought is a common practice. Just because I tell you to hold a split squat and make sure your knee lines up with your second toe doesn’t mean you are more stable. It means you can consciously correct your position.
Stability happens too fast for conscious thought. This is apparent in athletes who have good form and control in the gym, but quickly break down once they get into their training. Unless we create reflexive control in our stabilizers we are still at risk of dysfunctional movement patterns.
How do we teach our body to do this unconsciously?
Over the years, several strategies that have worked best are reactive neuromuscular training (RNT) and various self-limiting exercises. Reactive neuromuscular training is using a stimulus (band, physical touch, etc.) to push a specific joint into the unwanted position. The goal is for the body to autocorrect through reflexive control and re-establish a good joint position. Here is a sample RNT drill using the split squat:
Various self-limiting exercises I have used are in split stance or single leg stance while on a board or some type of balance beam. Why I love to use these structures is because once stability is lost the body loses the ability to remain on the board. Therefore, every loss of control magnifies itself. Creating an environment that rewards quality movement is key. This is the opposite of running and other forms of exercise which allow individuals to move for mile after mile despite poor form and mechanics.
4. Optimal Positions for Developing Stability
It’s important to know which positions create better stability. Yes, single leg stability is the end all be all, but we can use other positions to help bridge the gap to our end goal. I say this because oftentimes people find their balance is poor and continue to work on the hardest balance exercise out there with limited success. Let’s try taking a step back to some of these alternate positions that foster learning and appreciation before progressing ahead.
Two positions that I have in mind are 1/2 kneeling and split stance. Essentially they are the same position, but one is on the ground while the other is elevated. The beauty is you can use them for different reasons, such as: core, upper body, and lower body.
1/2 kneeling and split stance reduces the equal contribution of the core and hip musculature on the pelvis. Instead, it requires the body to maintain a level pelvis while the legs are in opposite positions. This is essential for runners who complete this exact motion in a faster and more repetitive fashion.
You may be wondering, what exact exercises do you mean? Previously I mentioned core, upper body, and lower body, so here are my favorites that fit that criteria:
5. Is a Joint Mobility/Flexibility Restriction Causing Your Stability Issue?
When trying to improve lower extremity stability and control, it’s common to program stability and balance exercises, right? This would make perfect sense if there were no underlying mobility restrictions. But, if you are lacking optimal mobility or are really tight, what takes precedence?
Several years ago, I was at the Perform Better Summit and heard an interesting concept regarding the impact of mobility on stability. It was said that when a joint lacks range of motion, it tends to reduce the stability output.
Range of motion and joint mobility provide a proprioceptively-rich environment in which sensory input is sent to the nervous system. When a joint lacks movement, the feedback loop is disrupted as there isn’t as much sensory information sent to the nervous system in which to respond to. This lack of mobility can therefore disrupt the subsequent stability.
Ever since I heard this concept taught this way, I always make sure to look at stability from a few different lenses. Essentially, do you have trouble stabilizing? Or, is your lack of range of motion creating poor stability?
6. Considering the Impact of Other Areas on Alignment
The lower extremity consists of a series of joints from the foot, ankle, knee, and hip. Since the ankle and knee primarily hinge with little rotation (besides just distally of the knee at the tibio-femoral joint), it’s important to look at the foot and hip in terms of alignment. These areas all contribute to alignment of the limb and one always affects the other.
The hip is a common focus in most running programs as it needs to possess adequate mobility, stability, and propulsion. But, excessive pronation of the foot can create a faulty alignment very similar to the hip
One area that need to be assessed is the medial longitudinal arch. The flexor hallucis brevis is an intrinsic foot muscle that spans across the arch and helps provide support to the foot. When lengthened or weak, this muscle fails to provide the control needed to support the arch, thus altering foot and lower extremity biomechanics. This also causes the knee to track medially and the hip will move into internal rotation. So, although it mimics a common hip dysfunction, it’s essential to assess other areas throughout the body.
The lumbar spine and rib cage are also important to lower extremity alignment as they lay the foundation for pelvic position. All of the musculature surrounding the core attach to the lumbar spine, pelvis, and rib cage. When poor alignment and control of these areas are an issue, the lower extremity can often be viewed as dysfunctional.
With how interconnected this region is, I find that the rib cage and lumbar spine can dictate the position for one another. Flared ribs is commonly seen with excessive lordosis and possibly an anterior pelvic tilt. And vice versa. Also, any scoliosis or restriction at the spine can cause altered pelvic positioning such as upshifts/downshifts and rotations.
Anyway, I hope you enjoyed this recent edition of ‘Random Thoughts.’ Feel free to comment below or on Facebook with your questions or insights on the topic.
By: Garrett McLaughlin, MS, ATC, CSCS, ART